Individual
MOSUNMOLA SANDRA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-BC
Contact information
Practice address
6215 GREENBELT RD STE 107, BERWYN HEIGHTS, MD 20740-2355
(301) 272-1558
(301) 272-1559
Mailing address
10801 GREEN ASH LN, BELTSVILLE, MD 20705-3851
(301) 263-4890
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R191756
MD
Other
Enumeration date
08/29/2017
Last updated
07/21/2022
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